"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." Dr William Osler

1. Disclaimer: Having made the move from medical student to Intern, and just in case it is not obvious. Everything here is my personal opinion and not that of my employer. Also wrote it after working overtime last night so please excuse any spelling mistakes or poor sentence structure.

All of us have teachers throughout lives, who act as guides through the various hurdles of life. In the medical profession it is our seniors who act as these guides. To help us not only avoid hazards, but also to get our bearings. And while without them we may endure, it’s at what cost.

In the past few months, there has been a looming threat to the ability of our seniors to continue their role as clinician and teacher. As of November last year, the Queensland Government has been attempting to push senior doctors onto individual contracts. Contracts which potentially strip away basic working conditions, and put patients at risk.

This story has been told time and time again elsewhere (see links and resources below). So I would like to add a new face to this story, that of a junior doctor losing their teacher. This is not a commentary on the contracts themselves, but rather on how we as doctors are educated and the potential consequences of losing our most senior doctors.

I'll start off my tale by reflecting on the quote from the start, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." While I've liked this quote, I often felt it missed something. That is, that having an experienced skipper on board can also make you're travels along the open sea a little smoother.

As junior doctors, we have read the books, seen some patients, but at this stage in our careers we've been comparatively just sailing off the coast of Australia. We can work competently within our knowledge, see 'hopefully' obvious hazards, but still need that second more experienced set of eyes, to avoid the hazards below the surface. Our senior doctors also provide us with ongoing education, tips and tricks, and a wealth of experience on how to navigate various encounters with our patients. This process of teaching, is to allow us to build our own bank of knowledge, drawn from the books, the patients, and the experience of our teachers, so that we can more comfortable navigate the open seas. Most importantly, sometimes we will even get caught on a metaphorically reef, and we will need an experience skipper (i.e. senior doctors) to help us get off it.

When we lose our senior doctors, we are also losing our teachers. If we were to lose one, that would be an unfortunate loss. But the loss of many, would not only have grave consequences to our education, but also to any treatment provided to patients. And the to nip this in the bud now, the answer is not as simple as replacing Doctors with Doctors, or playing the numbers game. If we were to play the number game, it should be only to consider the wealth of knowledge that we have lost, if senior doctors decide to go elsewhere. Medical knowledge, knowledge about the environment that we work in, knowledge about the system, and knowledge about our patients.

To continue playing the numbers game, a loss of a specialist, can be loss of training place. So we are losing not only the doctor already specialised in that area, but any doctors training on that specialty training program as well. In regional hospitals, a loss of a specialists can lead to more serious consequences such as complete loss of accreditation for training places. The flow on effect of this, is that Doctors in-training for specialties will have to seek employment elsewhere. Thereby causing some regions to become short of qualified specialists in various fields.

Our senior doctors, play a vital role in educating the next generation of doctors. So whilst I said I would not comment on the contracts, I do have one plea. Let's go back to the drawing board, keep the dialogue going and come up with a solution before it's too late. 


For a summary of the medical training pathway see below. Importantly, up until the end of the diagram, where we are specialists, it is a requirement for us to be supervised in some matter.

Happy to answer questions or respond to further questions as they come.

An ounce of sensible policy prevents tonnes of human suffering. Rob Moodie

Keep Our Doctors Campaign & News

Keepourdoctors.com.au
◘   Facebook:
      https://www.facebook.com/keepourdoctors
◘   Twitter:
      https://twitter.com/KeepOurDoctors
◘   Youtube:
      https://www.youtube.com/user/keepourdoctors

1. Turmoil for Queensland doctors as contracts introducedTrent Yarwood, specialist infectious diseases physician and member of the Far North Queensland Senior Medical Staff Association for this overview of the current disquiet amongst Queensland doctors.
   ◘    http://blogs.crikey.com.au/croakey/2014/03/05/turmoil-for-queensland-doctors-as-contracts-introduced/
2.  
3. Top neurosurgeon Lindy Jeffree warns patients will die if Newman Government forces doctors to sign individual contracts.
   A RESPECTED neurosurgeon is planning to leave the public hospital system and set up private practice because of the Newman Government’s controversial individual contracts.
   Health Minister Lawrence Springborg has declared that negotiations are over.
   ◘   http://www.couriermail.com.au/news/queensland/top-neurosurgeon-lindy-jeffree-warns-patients-will-die-if-newman-government-forces-doctors-to-sign-individual-contracts/story-fnihsrf2-1226843044095
4. 
   
5. Newman’s attacks on our health system will hurt the poorest and sickest
   ◘   http://www.theaustralian.com.au/national-affairs/opinion/newmans-attacks-on-our-health-system-will-hurt-the-poorest-and-sickest/story-e6frgd0x-1226841431954
6. 
   
7. State Government MP Chris Davis slams LNP over doctor contract plan
   QUEENSLAND’S assistant health minister Chris Davis has hit out against the Newman Government’s controversial individual contracts for public hospital specialists.
   ◘   http://www.couriermail.com.au/news/queensland/state-government-mp-chris-davis-slams-lnp-over-doctor-contract-plan/story-fnihsrf2-1226844090955
8. 
   
9. Queensland coroner Terry Ryan warns public specialist contract row will delay funerals and autopsies
   THE state coroner has warned of delays in funerals and backlogs in coronial investigations if the controversy over individual contracts for public medical specialists is not resolved.
   ◘   http://www.theaustralian.com.au/news/queensland-coroner-terry-ryan-warns-public-specialist-contract-row-will-delay-funerals-and-autopsies/story-e6frg6n6-1226841429382

Medical Training Pathway

 

Adapted from Interncrisis.org.

Obstetrics is the field of medicine which encompasses the care of a woman during pregnancy and childbirth. In that way it is very unique, as when assessing these patients, your actually also assessing another the child. Consequently, the approach to history taking in Obstetrics whilst similar to other fields of medicine, includes a number of additional components.

The following is a guide to taking an Obstetric History, that will ensure you miss none of the key components.

Presenting Complaint
What is the problem that brought you to the hospital/clinic?

Some common presenting complaints include;

1. ◘   Bleeding
2. ◘   Abdominal Pain
3. ◘   Hypertension
4. ◘   Physiological complaints due to pregnancy

The patient may also be presenting as part of standard antenatal care (as per your local guidelines).

History of Presenting Complaint
Often there will be overlap between the history of the presenting complaint and the history of the current pregnancy.

History of Current Pregnancy
The history of current pregnancy should ideally be considered by the different trimesters to date. This will be useful for understanding common issues that arise at each stage, and also determining appropriate antenatal care and management.

General Questions

1. ◘   Last menstrual Period (LMP)
2. ◘   Estimated delivery date and approximate Gestational Age.
3. ◘   Any concerns about your pregnancy
4. ◘   What are your expectations regarding your pregnancy

First Trimester

1. ◘   Further details regarding menstrual history (as below)
2. ◘   Was the Pregnancy planned?
3. ◘   How was the pregnancy confirmed?
4. ◘   Signs and symptoms of pregnancy.
5. ◘   How/has the pregnancy been dated (e.g. dating Ultrasound Scan)?
6. ◘   What tests and scans have you had to date?
7. ◘   Current medical illnesses and medications.

Second Trimester

1. ◘   Any problems during second 3 months?
1. o  Bleeding, vaginal discharge, urinary problems and so on.
2. ◘   Last visit to the doctor?
1. o  Has an Ultrasound scan (e.g. morphology scan) been done?
2. o  Blood tests to date?
3. o  Blood pressure?
4. o  Growth of foetus, placenta location.

Third Trimester

1. ◘   Any issues after the first 6 months of your pregnancy?
1. o  Bleeding, vaginal discharge, urinary problems, labour pain.
2. o  Blood pressure
3. o  Glucose
4. o  Test results
2. ◘   Any plans or ideas about method of delivery.

Past Obstetric History
Gravidity: the number of times a woman has been pregnant, regardless of the outcome.
Parity: the number of times a female has given birth to a baby.

There are many different methods and protocols by which Gravidity and Parity are denoted, please be aware of your local policy and documentation guidelines.

A simple system commonly used in the UK is;

GPx+y

where

G= Gravidity, P = Parity: X = (any live or still birth after 24 weeks);

Y = (number lost before 24 weeks)

A woman who has never given birth is a nullipara, a nullip, or para 0.
A woman who has given birth two or more times is multiparous and is called a multip.
A woman in her first pregnancy and who has therefore not yet given birth is a nullipara or nullip. After she gives birth she becomes a primip.

A woman who has given birth once before is primiparous, and would be referred to as a primipara or primip.

Details of each pregnancy

1. ◘   Dates of deliveries
2. ◘   Length of pregnancies
3. ◘   Singleton/twin and so on
4. ◘   Induction of labour/Spontaneous
5. ◘   Mode of Delivery
6. ◘   Weight of babies
7. ◘   Gender of babies
8. ◘   Complications before, during and after delivery

Number of miscarriages, terminations and/or ectopics – with appropriate details.

1. ◘   This question should be asked as some patients will not consider the above situations as pregnancy.

Any difficulties conceiving and any treatment/management to date for sub-fertility.

Past Gynaecological History
If it hasn’t been so already, you should first gain a Menstrual History as appropriate.

1. ◘   1st day of last menstrual period
2. ◘   Duration and regularity of normal cycle
3. ◘   Flow: heavy/light, clots, number of tampons/pads used
4. ◘   Pain

Last Cervical Smear (Pap Smear): when and results.

Any Gynaecology Surgery?

1. ◘   D&C
2. ◘   Loop excision of transitional zone (LETZ)
3. ◘   Previous C-Sections

Treatment or investigations for; ectopic pregnancy, pelvic inflammatory disease, infertility
This may be an appropriate place to take a Sexual History (see sexual history for further details).

Past Medical & Surgical History
Current or past illnesses

1. ◘   Hypertension
2. ◘   Diabetes
3. ◘   Epilepsy
4. ◘   Thyroid (hypo or hyper)
5. ◘   Thromboembolic disease
6. ◘   Asthma

Hospital Admissions: when, where and why.
Surgical procedures

1. ◘   when, where, why and details concerning procedure
2. ◘   abdominal or gynaecological procedures
3. ◘   problems with anaesthesia
4. ◘   problems with bleeding (requiring transfusion) or clotting

Vaccinations/immunisations up to date?

Current Medications & Allergies
Medications can be divided into prescribed medications and non-prescribed medications/herbal remedies. The latter should not be missed, and approached in non-judgemental way.
Allergic to any medications?

Family History

1. ◘   Medical conditions
2. ◘   Obstetric complications
3. ◘   Genetic conditions

Social History

1. ◘   Occupation
2. ◘   Relationship Status
3. ◘   Diet/physical activity
4. ◘   Smoking
5. ◘   Alcohol
6. ◘   Drug use
7. ◘   Living Situation
8. ◘   Travel History

References

1. ◘   ABC of labour care - Obstetric emergencies http://www.bmj.com.ezproxy.library.uq.edu.au/content/318/7194/1342
2. ◘   Borton, Chloe (November 12, 2009). "Gravidity and Parity Definitions (and their Implications in Risk Assessment)".
3. ◘   The Medical Significance of the Obstetric H... [Am Fam Physician. 1983] - PubMed - NCBI.

 

IVLine has been running for a nearly 4 years now (or basically the length of my medical degree), and it's been a great journey to date. However, with every year that passes IVLine looks a little older and it now seems that IVLine requires a bit of a facelift.

It's time for a makeover.

This means a whole new IVLine is going to you in 2014. For starters say goodbye to IVLine.info and say hello to IVLine.org. Don't worry you'll still be able to access the site by IVLine.info, however if you have any pages bookmarked you'll have to change them.

What other features are planned?
Firstly, I'll be updating the design of the site so it's responsive. That is, it will adapt to suit your device; whether it be Computer, Laptop, Tablet or Smartphone.

Secondly, I'm not just about turning an ugly duckling into a pretty face. The site structure and navigation system is going to get a revamp.

Thirdly, out with the Blogger Commenting System and in with Disqus. This will make it easier for more people to comment and facilitate conversations.

There is much more coming in 2014, but I will leave you with the above for now.

Temporary Hiatus
To achieve all of this IVLine will be temporarily shutdown from the 25th December 2013 to the 1st January 2014.

Finally Merry Christmas, and hope to see you all in the new year.

A small collection of Obstetric summaries that I made whilst studying for my exams, that I thought would share with the greater world. They cover aspects like clinical features, investigations, risk factors and basic management.

If something is wrong with any of them let me know and I'll make a note of it here. They're all solo takes, so it may seem a little all over the place with plenty of 'ums' and 'ahhs'.

Preterm Labour

Just a note, though I didn't state it preterm labour is obviously labour before term.

Link

Gestational Diabetes

Link

Pre-eclampsia

Link

Obesity in Pregnancy

Link

Ectopic Pregnancy

Link

VTE Prophylaxis in Pregnancy

Link

 

JAM aka Just A Minute Medicine is a concept of quickly presenting the most pertinent facts in a video format. They are designed to act as quick refreshers of the most important information, that will guide clinical practice.

This video by Dr Tim Leeuwenburg from KIDoc.org explains the concept.

JAM series from Tim Leeuwenburg on Vimeo.

 There a quite few videos available online now following the JAM format; with topics like
Rapid Sequence Intubation through to a simple guide on how to use a turbuhaler device.

Obstetrics and Gynaecology Collection
The focus on this post however, will be to highlight some of the useful Obstetric and Gynaecology tutorials.

Why you ask? Because I just so happen to be on my Obstetrics and Gynaecology term.

And that's all the JAM folks.

Checkout Short Podcasts on Obstetrics for some more material.

It's been over 3 and half years seen I wrote my original Top Online Resources for Medical Students, and we have come a long way. While there are still some of the old-favourites hanging around, there are also a whole bunch of newcomers to the online sphere. 

So after initially writing a list at the start of medical school, I'm now writing one at the end. This is by no means a comprehensive list, rather a list of resources that I found particularly useful throughout my medical school life. Feel free to add you own top resources in the comments section below.

Please note the majority of resources included in this list are all freely available, however some more comprehensive options do exist that require payment/subscription. I also recommending checking what online resources are provided by your Medical School/Hospital.

General
LifeintheFastLane

www.lifeinthefastlane.com

Lifeinthefastlane (LITFL) is one of my all time favourite resources, and probably the one I've used most on a regular basis. LITFL is a blog targeted at sharing emergency medicine and critical care knowledge, yet it's whole library of posts offers up much more to the reader.

Due to it's awesomeness, I'm not going waste any more time apart from saying, Go Check It Out!

Global Medical Education Project

www.gmep.org

The Global Medical Education Project (covered in a previous post) is a repository of medical information, images, videos and questions. It is an interactive network allowing people to tag media, vote questions up and down and comment on work.

The NNT

www.thennt.com

An Evidence Based Medicine (EBM) website evaluating therapies and diagnostics. It is a useful resource to use to see an overview of the evidence behind different therapies and diagnostics. Cover a range of specialities from Cardiology through to Urology.

GuidelinesForMe
www.guidelinesforme.com

A database of guidelines collated from around the globe.

MDCalc

www.mdcalc.com

A medical calculator and equations website for clinical calculations, scores, equations, outcomes, mortality and risk stratifications.

SketchyMedicine
www.sketchymedicine.com
I'm a very visual learner and SketchyMedicine is one of the blogs I frequently stop by to have a look.
There are some great doodles that cover a number of aspects of medicine; everything from internal medicine through to basic anatomy.

Khan Academy
www.khanacademy.org
Khan Academy is a huge educational initiative comprising of 100s of videos. Best used for learning your basic sciences, or maybe just learning something new entirely.

You can also access their library on your mobile or tablet through the KhanApp.

Handwritten Tutorials 
www.handwrittentutorials.com
Simple. Handwritten video tutorials on basic physiology and anatomy. If you're a visual learner like me than these are high yield.

Lab Tests Online
http://www.labtestsonline.org.au/
Labs tests online helps the clinician understand clinical laboratory tests. It provides information on individual tests (e.g. eLFTs), on tests for diagnosing or asessing (e.g. Anaemia) and tests for certain population groups (e.g. neonates). It contains information that has been localised to more than 15 different countries (from Australia through to the United States of America).

Android and iPhone apps are also available.

Anatomy

BioDigital Human
https://www.biodigitalhuman.com/home/
The BioDigital Human is a virtual 3D body that brings to life thousands of medically accurate anatomy objects and health conditions in an interactive Web-based platform.

Zygote Body
http://www.zygotebody.com/
An offshoot of the original GoogleBody, Zygote body provides another 3D view of the human body.

AnatomyZone
http://www.anatomyzone.com/
AnatomyZone harnesses some of the above resources to create Anatomy tutorials useful to a wide range of different users, from nurses, to physiotherapists, to osteopaths, to medical students.

Clinical Examination
The Stanford Medicine 25
http://stanfordmedicine25.stanford.edu/the25
This website produced by Stanford covers 25 common clinical examinations. It includes the usual collection of text, images and videos.

GeekyMedics
http://geekymedics.com
A popular site amongst many medical students, GeekyMedics covers the basics of history taking and clinical examination in an easy and friendly way. Aside from their clinical examination posts, they also have a collection of posts relevant to OSCEs, Medicine, Surgery and Emergency.

There is also a clinical skills section on IVLine, which has a number of useful videos from the University of London.

Cardiology
ECGPedia
http://en.ecgpedia.org/
A free electrocardiography (ECG) tutorial and textbook to which anyone can contribute ,
pitched at medical professionals and keen medical students. Also includes a number of case studies.
If you're looking for a place to start in understanding ECG this is one I would recommend.

Profmontage
http://www.profmontage.com.au
ProfMontage provides a video tutorial series on clinical cardiology, cardiac physiology and clinical epidemiology. The videos are short and snappy (being all less than 3 minutes) and features a cast of characters from Xtranormal.

You may recognise the use of XtraNormal from this classic Orthopaedic vs Anaesthesia Battle.

LearntheHeart
http://www.learntheheart.com/
Learn the heart is a website highlighting some of the big ticket items in cardiology.

Blaufuss Multimedia
http://www.blaufuss.org/
Want to hear a heart murmur? Blaufuss Multimedia has a number of tutorials on hearts sounds, as well as ECG and arrhythmias.

CV Physiology
http://www.cvphysiology.com/Tutorials/tutorials.htm
Tutorials and quizzes on cardiovascular physiology; from arrhythmias through to peripheral artery disease.

Quick Guide to ECG
http://www.ivline.org/2010/05/quick-guide-to-ecg.html
The most popular post on IVLine, this post gets people coming back time and time again. It runs through the basics of ECG and provides a quick guide on how to report an ECG back to a colleague.

Emergency Medicine
Note emergency medicine is renowned for a having very active group of clinicians and students worldwide publishing content. While I would love to include everyone on this list, I resorted to selecting just a few of my regulars. If you wish to find more it's worth checking out #FOAMed on twitter which is where all the emergency physicians spend their days.

AcademicLifeinEM
http://academiclifeinem.com/
Academic Life in EM started by Michelle Lin (@M_Lin), provides a wealth of resources on Emergency Medicine topics. With consistently good content, this is not one to miss. My two personal picks from this site are; Tricks of Trade and her Paucis Verbis (PV) cards. The PV cards are available on iOS, Android, Evernote or Dropbox.

Patwari Academy
http://www.youtube.com/user/oldblueday
If you haven't realised by now, I'm a bit of a visual learner. Patwari Academy is a series of video tutorials on emergency medicine and evidence based practice by Rahul Patwari. The videos are broken down into digestible bits, with often a topic like Advance Life Support running over a number of videos.

EMCrit
http://emcrit.org/
Scott Weingart (@EMCrit) the author of EMCrit, too many feels like the god of Critical Care. Not surprisingly his blog is a gold mine. While I wouldn't recommend this blog to kids just kicking off their medical training, this is one for anyone passionate about critical care.

Anatomy for Emergency Medicine
http://emergencymedicineireland.com/anatomy-and-em/
Anatomy for Emergency Medicine is a podcast series which delivers doses of anatomical knowledge linked in with clinical scenarios. Often we learn anatomy simple as remember this goes here and does this. These podcasts series, ties our anatomical knowledge (or lack thereof) into the clinical scenarios some may face on a day to day basis.

Ultimate Guide to Trauma
http://www.ivline.org/2012/04/ultimate-guide-to-trauma.html
The Ultimate Guide to Trauma is a collection of posts from blogs like Lifeinthefastlane, Academic Life in EM, EMCrit and so on, which offers a starting point for those interested in understanding the approach to trauma in general and specific scenarios.

Histology/Pathology 

Blue Histology
http://www.lab.anhb.uwa.edu.au/mb140/
A collection of images, notes and quizzes from the University of Western Australia.

Shotgun Histology
http://www.youtube.com/user/WashingtonDeceit
Another long-standing favourite of medical students. Shotgun histology features selection of videos investigating the histology of different tissues. A highly valuable resource for those who have had no experience in histology. To watch in a series, view this playlist.

 

PathologyStudent
http://www.pathologystudent.com/
Pathology Student's motto is 'making pathology easy and fun. While I can't comment on the fun part (being not a huge fan of pathology) it certainly makes it a bit easier and in my opinion bearable. Pathology student is regularly updated and has some useful study guides.

Internal Medicine
Internal Medicine Introductory Lecture Series
http://www.uth.tmc.edu/schools/video/streamvideo/ms/im/imedls.html
A series of video lectures from the University of Texas on internal medicine topics.

Clinical Cases
http://clinicalcases.org/
Clinical Cases and Images is a useful resource that brings together various pearls of medical wisdom and aims to bridge the gap between clinical theory and practice. It is a well supported and recommended blog, having been featured in 14 peer-reviewed medical journals and other scientific publications.

General Practice
GPnotebook
http://www.gpnotebook.co.uk/
GPnotebook is an online encyclopaedia of medicine pitched at general practitioners.

FamilyPractice Notebook
http://www.fpnotebook.com
Almost like the younger cousin of GPnotebook. Between the two you should be able to find what you are looking for.

Nephrology

Nephrology On-Demand

www.nephrologyondemand.org

Nephrology on Demand from the University of Eastern Carolina is a regularly updated website, with pearls, histopathology, videos and general renal goodness.

Precious Bodily Fluids
http://www.pbfluids.com/
Handouts, powerpoints and a handful of blog posts since 2007, Precious Bodily Fluids is another a would recommend to get started with nephrology.

Neurology

Rather than do too much leg work, when I see a good resource I share it. Eve Purdy from Manu et Corde has put together a list of useful neurology resources.

Draw it to know it
http://www.drawittoknowit.com
Not exactly free (except for a free trial) and not strictly neurology, Draw it to know it is a site that gets you to draw neuroanatomy to remember it. I include it here, as I've found it useful at times; for both myself and students I've taught neuroanatomy too.

Ophthalmology
OphthoBook
http://www.ophthobook.com/
OphthoBook is what I would call the simple guide to Ophthalmology. In fact, for medical students I would probably just call it the complete guide. Written by Dr Tim Root, it contains some funky cartoon images, videos galore and all the basics you need to know about Ophthalmology.

The Eyes Have It
http://www.kellogg.umich.edu/theeyeshaveit/
An tutorial and quiz website provided by the University of Michigan. Though I like to think of it as an atlas with some questions. Best of all if you're looking to share all their content is licensed under creative commons.

IVLine: Clinical Examination of the Eye

Orthopaedics
AO Surgery
https://www.aofoundation.org/wps/portal/surgery
The AO Surgery Reference is a huge online repository of surgical knowledge, consisting of more than 7000 pages. It overviews surgical procedures, surgical decision making, and has an abundance of images and videos Simply select an area of anatomy then work through Diagnosis, Indication, Preparation, Approach, Reduction & Fixation and Aftercare.

Plus it can be accessed on you smartphone or tablet.

WorldOrtho
http://www.worldortho.com/
WorldOrtho is a site dedicated to Orthopaedic resources and learning. The Simple Guide to Orthopaedics and the Simple Guide to Trauma are two useful ebooks.

Videos by Dr Nabil Ebraheim
http://www.youtube.com/user/nabilebraheim/videos
Videos on anatomy, signs and symptoms. Plus a few of the common rheumatological and orthopaedic conditions.

Wheeless' Textbook of Orthopaedics
http://www.wheelessonline.com
To be honest I'm really not a fan of this site, but it gets recommended to me so often I've included it here. I'm sure the information is actually pretty good, but the layout and design, just make we want to stay well clear of this site.

Paediatrics
Royal Childrens Hospital (Melbourne)
http://www.rch.org.au/clinicalguide/
A complete suite of clinical practice guidelines and tips developed by a team of paediatricians. Updated frequently and available on your mobile devices.

Pediatric Surgery Handbook
http://med.brown.edu/pedisurg/Handbook.html
A quick and easy guide on the basics of Paediatric Surgery provided by Brown University.

There are a collection of paediatric resources available at www.generalpediatrics.com

Radiology
Radiopaedia
http://radiopaedia.org/
A huge encyclopaedia of radiology knowledge. It has over 13000 cases, nearly 6000 articles which continues to all the time. Nearly anyone can be part of it, and it can accessed through their dedicated mobile apps.

Radiology Masterclass

http://www.radiologymasterclass.co.uk/
Whereas Radiopaedia feels like a reference site or wiki to all radiological knowledge, Radiology Masterclass has a structured tutorial breakdown. This allows you to work step-by-step through areas of firstly interest (e.g. by anatomy) followed by skill level.

Rural Practice
Rural Doctors
http://ruraldoctors.net/
This site is for clinicians who want to keep in touch with the latest in medical education concepts applicable to rural practice, listen to relevant podcasts and share thoughts on typical cases, using info from the wider medical education community.

Surgery
SurgWiki.com
http://surgwiki.com/
Surgwiki is brought to you by the ANZ Journal of Surgery and has a number of contributors and editors from across the globe. It is broken down into four main components; General concepts, Surgical technique, Peri-operative care and Specialty interests.

Subscription Services

Here are some paid services I particularly like.

• BMJ Best Practice
• MDConsult
• AccessMedicine

I used to be a fan of Uptodate however it's not as useful to an Australian practitioner. In addition, BMJ Best Practice provides a great iPad App.

Summary
So that's a wrap-up of some of the resources I found most useful during my medical degree. I have obviously not had the chance to do every speciality throughout my years of training. And a few of the resources have obviously been due to their relevance to the Australian practitioner.

So I encourage everyone to share of their favourite below in the comments section or on twitter under #FOAMed.

Photo Atrribution

• Studying by Saad Faruque

 
So you have now purchased a purchased a bunch of apps, to enhance your iPad to the next level. Yet now your iPad screens are starting to look a little cluttered; Time to Organise. There are several ways in which you can organise your apps and webclips (more on webclips in a future episode), but Folders are the primary choice.

After getting your iPad organised you may also wish to share the content on your iPad and bring your home network content to your iPad. You can share music, videos and much more between your iPad and home devices and we will show how to set this up in today's episode.

In this episode we take a look at how to find the apps we are after quickly (especially good quality medical apps), how we can launch apps, how we can delete them and how we can update them.

Several methods we cover for finding apps include;

• Appstore
• Discovr
• iMedicalApps
• Lifeinthefastlane.com Tech Thursdays
• Apps gone free

and many more...........

In the next episode we look at ways of organising your apps and webclips into folders, sharing your music and video library around the house, and sharing your iPad with family members.

As always for more details on each episode go to the Pimp my iPad series on Lifeinthefastlane.com

  

Despite all the changes Apple has made to the Appstore, finding good quality medical apps can still be a challenge. This is where reviews and word of mouth play an important role in aiding health professionals find the gems amongst the rough. If you have been following the Pimp my iPad series, you will now have the basics down. Now it's time to start installing apps. If you can't hold out till next week's episode, I've included the first 30 reviewed apps from TechTool Thursday.

TechTool Thursday is a regular feature on LifeintheFastLane.com written by the knowledgeable Dr Tessa Davis (@TessaRDavis). Each week a new app is reviewed, looking at it's pro, cons, uses and where it could be improved. 

Critical Medical Guide
The Barringer Group, LLC
Critical is an emergency medicine and general medicine reference app that provides the user with guidelines and information about treatment.  It has a large range of resources including videos, images, calculators and scoring systems.

Full review: TechTool 019
Rating: 9/10
iTunes - Android - Website

drawMD - Free
UrologyMatch
drawMD is a beautiful app for the iPad that allows you to explain procedures and illnesses to your patients by using customised diagramatic visual aids.  The app provides templates for anatomical explanations and you can customise these by adding extra stamps or your own drawings.

Full Review: TechTool 025
Rating: 9/10
iTunes - Website

EM Procedure Log
Baker Hamilton
EM Procedure Log is a simple way of keeping a log of clinical activity.  This can be procedures as the title suggests but could also be cases, presentations or other useful logs.  Data is stored on the phone and can be shared via dropbox.

Full Review: TechTool 015
Rating: 7/10
iTunes - Website

EM Rashes
Emergency Medicine Residents’ Association
EM rashes is designed to give the user an algorithm for quick diagnosis of rashes as they present in ED.  The user answers a few simple questions about the rash & is taken to a page with information about the differential diagnoses.

Full Review: TechTool 012
Rating: 4/10
iTunes - Website

Emergency Medicine Ultrasound
EM Apps
Emergency Medicine Ultrasound gives guidance on performing emergency ultrasound procedures.  It gives the user an overview of the scan procedure and some examples of normal and abnormal scans.  Extra sections assist with dictating ultrasound reports.

Full Review: TechTool 006
Rating: 7/10
iTunes - Facebook

ERres
Denali Apps PLC
ERres assists ED trainees in their day-to-day practice.  It provides algorithms, guidelines, doses and decision rules covering all areas of Emergency Medicine.

Full Review: TechTool 008
Rating: 8/10
iTunes - Android - Website

GenSurgCall
Jeremy Tan
GenSurgCall is a quick-reference guide, which gives a brief overview of general surgical problems.  It’s most useful for med students and very junior doctors.

Full Review: TechTool 018
Rating: 6/10
iTunes - Website

iLarynx
Glassenberg
iLarynx is a simulation game where the aim is to try to simulate fibreoptic bronchoscopy by manipulation and advancing the scope at the right time.

Full Review: TechTool 021
Rating: 5/10
iTunes - Website

LactMed
National Library of Medicine
LactMed provides information about the side effects of medicines when breastfeeding. The user searches for the drug they are prescribing and detailed results come back from the database about potential adverse effects.

Full Review: TechTool 014
Rating: 6.5/10
iTunes - Android - Website

MediBabble
NiteFloat, Inc
MediBabble is a translator app for clinicians to help communication with patients.   Select the language, and then guide the patient through the clinical history and examination.

Full Review: TechTool 005
Rating: 9/10
iTunes

Medrills – Airway
ArchieMD, Inc
Medrills Airway is a simulation app like no other.  It is primarily aimed at paramedics but could be useful for ED medics too.  The module provides instruction on good airway management followed by some simulated scenarios and questions to test and develop your skills.

Full Review: TechTool 017
Rating: 7/10
iTunes - Android - Website

palmPEDi
palmER Worldwide LLC
palmPEDi provides quick access to important drug doses for paediatric emergencies.  It’s all done by weight (or an estimated weight based on age). Select the weight and a long list of drug doses are at your feet (fingertips).

Full Review: TechTool 011
Rating 8/10
iTunes - Website

Paracetamol Overdose
IEDapps
Paracetamol Overdose is for assessing and managing paracetamol overdoses.  It tells you how to assess risk, when to treat and gives you specific guidance based on your patient.

Full Review: TechTool 001
Rating: 7/10
IEDapps - iTunes

Pediatric Oncall
Pediatric Oncall Private Limited
Pediatric Oncall is a mobile app produced by the website and it aims to encompass everything you might every want for paediatrics (or pediatrics).  It contains calculators, drug dosing, MCQs, video podcasts, poisons information, an image gallery and more.

Full Review: TechTool 022
Rating: 7/10
iTunes - Website - Android

PicSafe Medi
PicSafe
PicSafe Medi offers a secure way for you to take patient photos and record consent.

Full Review: TechTool 023
Rating: 6/10
iTunes - Website - Android

Pocket Eye Exam
NOMAD
Pocket Eye exam is an app for testing eyes and for learning about the common ophthalmological assessments.  It has been designed by Biomedical Engineering students and Neurologists.

Full Review: TechTool 020
Rating: 8/10
iTunes - Android - Website

PressorDex
Emergency Medicine Residents’ Association
PressorDex is an app version of John Greenwood’s book, which is a handbook for treating critically ill patients.  It contains guidance on medications, infusions, treatment, diagnosis and has inbuilt calculators.

Full Review: TechTool 024
Rating: 7/10
iTunes - Website

Read
QxMD
Read by QxMD’ provides a single place to discover new research, read outstanding topic reviews and search PubMed.

Full Review: TechTool 026
Rating: 8/10
iTunes - Website

Radiopaedia
Radiopaedia Pty
Radiopaedia is a spin-off app from Radiopaedia.org. It allows the user to work through real-life patient cases and interpret their imaging results to come to a diagnosis.  There is a mountain of information in the app if the user wants to learn more.

Full Review: TechTool 004
Rating: 9/10
Radiopaedia - iTunes

Resuscitation!
EM Gladiators
Resuscitation! is a patient simulation resus game.  A scenario is presented and you have to manage the patient exactly as would happen in an Emergency Department.  A final score is awarded depending on your actions.

Full Review: TechTool 003
Rating: 8/10
EM Gladiators - iTunes

Reversing Warfarin
HealthObs Ltd
Reversing Warfarin aims to help doctors manage their patients who are on warfarin.  It gives specific and clear guidance about what do to when faced with a raised INR, a bleeding patient, or a patient heading to theatre.

Full Review: TechTool 028
Rating: 8/10
iTunes - Website

SimMonitor
Med-eSim Apps
SimMonitor allows simulation teaching without having to drag out mannequins and large monitors.  Using just your iPhone you can provide a resus simulation experience providing ECG readings which you can adjust according to your student’s management.

Full Review: TechTool 002
Rating: 6.5/10
SimulationMonitor - iTunes

SimpLog
Azher Merchant
SimpLog allows you to keep track of patient follow-up from ED, so you will remember to chase results, call the patient to check their symptoms are improving or arrange follow up.

Full Review: TechTool 027
Rating: 3/10
iTunes - Website

Smart FOAM
iClinicalApps
FOAM collates free online medical education for everyone.  And Smart FOAM makes is even easier to acces.  Get it all for your mobile - it's free!

Full Review: TechTool 030
Rating: 8/10
iTunes - Android - Website

Survive Sepsis
John Richardson
Survive Sepsis offers guidance for clinicians to recognise and treat sepsis in adult patients quickly and effectively.

Full Review: TechTool 013
Rating: 7/10iTunes - Website

Toxbase
NPIS
Toxbase allows the user access to the Poisons Database.  All the information about drug toxicity, side effects and monitoring can be easily looked up on your iPhone.

Full Review: TechTool 010
Rating: 8/10
iTunes - Website

Upshot
Clay Smith
Upshot is a new app by Keeping Up, providing the user with succinct summaries of recent research.  The articles are digested and critically appraised, so a quick read is all that’s needed to keep up.

Full Review: TechTool 007
Rating: 6.5/10
iTunes - Android - Website

WIkEM
Christopher Kim
WikEM is a database of concise emergency medicine notes to assist physicians with their daily practice.

Full Review: TechTool 016
Rating: 7.5/10
iTunes - Android - Website

WoundSmart
Pocket Professions Inc
WoundSmart allows the user to keep track of patient wounds and document their progress.  As well as storing serial photos of the wound, the user can also enter all the patient information; detailed medical history and specifics about the size and shape of the wound.

Full Review: TechTool 009
Rating: 6.5/10
iTunes - Website - Twitter